Individual
DR. EDWARD W DAUTERIVE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 ANDRE ST, NEW IBERIA, LA 70563-2159
(337) 369-9309
(337) 365-8455
Mailing address
1100 ANDRE ST. STE. 101, NEW IBERIA, LA 70563-2159
(337) 369-9309
(337) 365-8455
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
014729
LA
2086S0129X
Vascular Surgery Physician
Primary
014729
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1339334
—
LA
Enumeration date
08/17/2005
Last updated
06/27/2008
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